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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804044
Report Date: 02/14/2023
Date Signed: 02/14/2023 11:04:44 AM

Document Has Been Signed on 02/14/2023 11:04 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:KREATIVE COMMUNITY SERVICES - BLOOMFACILITY NUMBER:
486804044
ADMINISTRATOR:ALOE, SHAYNEFACILITY TYPE:
775
ADDRESS:1241 ALAMO DRIVE SUITE 7TELEPHONE:
(707) 474-9653
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 60CENSUS: 14DATE:
02/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Shayne Aloe, AdministratorTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to complete an Annual Required 1-Year Inspection and met with Shayne Aloe, Administrator. At the time of inspection there were 14 clients and 12 staff in attendance at the Day Program.

Day program clients have a variety of social interactions, games, and activities. The day program is held in multiple activity rooms: music, art, game, sensory, fitness, computer nook, etc...During day program hours, clients are sectioned off into the various rooms. There are also dedicated bathrooms for clients, care center, (2) staff office, kitchen and storage area for program use. Facility is disinfected routinely. Clients' lunches are stored in the kitchen, and provided to clients during lunch time. LPA observed that both the bathroom and kitchen were sanitary and in good repair. There was hand soap and paper towels for clients' use. There was more than a 30 day supply of cleaning products in storage closet. All exits were unobstructed.

Facility has a Covid-19 screening station (disposable mask, thermometer, hand sanitizer). Visitors sign in on I-Pad. There are separate sign-in binders for staff and clients. Clients' temperatures are checked prior to arriving at the day program. There were hand sanitizing stations throughout the facility. Fire extinguisher was charged and serviced on 01/18/2023. The facility has an ample supply ofPPE including gloves, hand sanitizer, N-95 respirators, gowns, face shields, and surgical masks.


There were no deficiencies found at the time of inspection.
No citations issued.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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